A Toronto Star/Ryerson School of Journalism investigation has found that a lack of mandatory training for tattoo and piercing practitioners, along with sometimes lax enforcement against repeat offenders in Toronto, poses serious health risks.

Two weeks after Toronto inspectors documented serious “health hazards” at New York New York Accessories & Body Piercing, Carleigh Milton walked in to get her tongue pierced.

She knew nothing of the potentially bacteria-spreading concerns detailed in Toronto Public Health inspection reports — violations including no functioning sink and missing sterilization tests — when she stepped inside the Queen St. W. shop in June 2011.

Like most Torontonians who frequent any of the city’s 3,000 “personal service settings” — from tattoo parlours and body piercing shops to beauty salons — the 21-year-old assumed she was in safe hands.

Not so, she would learn.

A Toronto Star/Ryerson School of Journalism investigation has found that a lack of mandatory training for tattoo and piercing practitioners, along with sometimes lax enforcement against repeat offenders in Toronto, poses serious health risks.

Many of these establishments perform invasive procedures that break the skin, with risks ranging from minor skin infections to blood-borne diseases like hepatitis and HIV.

Like Milton, more than half the 216 complaints filed against Toronto personal service settings such as tattoo parlours since 2011 involved items that were not cleaned or sterilized, according to city statistics.

Last week, Toronto began licensing these establishments and requiring them to post inspection results in their windows — similar to the city’s DineSafe program for restaurants. York Region launched a similar initiative this month.

But that won’t address what public health experts call a sweeping problem inside establishments across the province, where operators often lack the training to safely perform invasive procedures with potentially serious health consequences.

“Personal service settings are being more commonly used and we do know infections can be spread through these practices,” said Dr. Barbara Yaffe, the city’s associate medical officer of health. “Some of them are not trained and when an inspector says, ‘How do you clean this?’ they don’t seem to have any idea. If they don’t understand, one is worried that they could be potentially putting the client at risk.”

On two occasions, in June 2011 and again this past February, city officials have written to the Ontario Health ministry asking it to impose a province-wide training regime. The province’s most recent response indicated it has no such plans in place.

Ministry officials say the current oversight model — in which establishments that don’t follow proper infection control procedures can face cleanup orders under the Health Protection and Promotion Act — is sufficient.

“I’m not aware of (province-mandated training) being on anybody’s horizon,” said Dr. Robin Williams, the province’s acting medical officer of health. “We’re always open to improving and if that’s what is needed and calls come from boards of health, I know the province would look at it.”

Pathogens on tools that break the skin “can be a risk,” but “the expectation of the province to boards of health is that they’ll offer (education) to operators.”

Local public health officials aren’t so confident.

In an industry with large staff turnover, where inspectors typically visit only once a year, a provincially mandated training regime would “make it much safer for the public,” says Dimitra Kasimos, Halton Region’s manager of enteric diseases.

“I think there’s a misconception in the public that just because a place is inspected, the person is trained and knowledgeable,” she says. “Literally anyone can open up an establishment offering these services, they don’t need any formal education . . . . If proper procedures aren’t followed, it’s a huge risk.”

Milton said her tongue piercing provided a graphic lesson in how untrained tattoo and piercing staff can threaten public health.

On June 15, 2011, a city inspector issued an order against two locations of New York New York for a series of health infractions related to equipment sterilization and inadequate infection prevention. Among other violations, documents showed no sterilization test records and improperly cleaned ear piercing guns despite being ordered to make the improvements “on four previous inspections.”

Sitting in a chair at New York New York’s location on Queen St. W. two weeks later, Milton’s suspicions were raised when the piercer aimed a needle at her tongue with what she says were unwashed, gloveless hands.

“The piercer . . . did the piercing with only one of her hands (gloved) and the ungloved hand frequently touched the inside of the complainant’s mouth during the process,” reads Milton’s complaint record logged by a city inspector.

In an interview, Milton recalled the female piercer having “super-long nails and I could see the dirt under them. I asked her to wash her hands and she said, ‘No.’ ”

Milton said the piercer struggled to jab a needle through her tongue web, essentially tearing her skin. She then dropped the tongue piercing on the floor, picked it up and sprayed it with hand sanitizer before asking Milton’s friend to attach it for her instead.

The next day, Milton said, the underside of her tongue was “swollen and full of pus.” She immediately complained to public health officials.

“The city should have shut down the place,” said Milton, who was relieved when her tests came back negative. “It seemed like I knew more about piercing than the operator did.”

In response to Milton’scomplaint, a city inspector paid a visit to New York New York’s owner, Reza Sattar. No inspection was conducted and no findings or enforcement measures were issued. The inspector instead offered him fact sheets and ran him through the province’s guidelines for infection prevention, the handwritten inspection record says.

“This is a lie,” Sattar said of Milton’s complaint. “I tell you that they abuse the health board for their personal issue. . . . She cannot prove my employee did this.”

Two weeks after Milton’s complaint, the city issued a news release urging customers who had received body piercings at New York New York or its second location on Wilson Ave. to get tested for hepatitis B and C, and HIV, noting it had no confirmed reports of infections.

In September 2012, city inspectors issued another order against Sattar for again failing to produce spore tests showing that machines used to sterilize critical instruments were in working order. He only showed tests for one of his three shops, and two of the results were failures.

Sattar said he lacked spore test results because at the time his employees were using disposable piercing materials, which don’t require sterilization.

“When you use disposable tools, you don’t have to do a lab test,” he said. “I try to explain the situation (to the inspectors) but they say they don’t understand. They are not educated.”

He admitted to two failed tests in 2012, but blamed them on an employee who conducted the tests incorrectly. He said his autoclaves are in good working order, and a failed spore test doesn’t mean items aren’t being sterilized properly.

“Sometimes my employees can make mistakes,” said Sattar, adding they don’t have any formal training specific to personal service settings.

“Training, there is a problem,” he said, adding he supports a province-wide mandatory training regimen in Ontario.

“There is no school. . . . The piercing business is just like the tattoo business. You go through apprenticeships. It’s individual training. Six months, somebody’s ready. There are no certificates.”

Some city councillors argue Toronto’s new licensing bylaw will do little to change a system where inspectors can check whether a sterilizer is working but have little power when they spot a clumsy, unskilled operator who could be endangering the safety of clients.

“There’s a gap in the legislation where there’s no provincial standard of what an actual artist or worker should know in terms of disease control,” said Councillor Glenn De Baeremaeker.

“There’s a problem with people not using equipment properly in those service shops. People are getting hepatitis B and C, and a variety of very serious skin infections.”

It is notoriously difficult to definitively trace blood-borne infections back to their source.

Of the 537 hepatitis C infections recorded in Toronto with known risk factors in 2011, tattoo and piercings were identified as a potential cause in 147 cases, second only to injection drug use. Of the 506 HIV cases the same year, tattoo and piercings were identified as a potential factor in 18.

While contracting a blood-borne illness is the worst-case scenario, reports of minor skin infections are far more common.

In May 2011, a woman said she developed a pus-filled rash across her bikini line after getting waxed at a Ray Daniels Salon in North York. A health inspector investigating the complaint found eight infractions, from a grease-filled footbath to an esthetician who admitted to improperly double-dipping an applicator into the wax.

Store owner Reza Khosravi was issued an order to correct problems “in order to decrease the effect of or to eliminate the health hazard,” the order reads.

In March 2012, an inspector found another 13 health infractions at the salon’s Yonge and Eglinton location, also owned by Khosravi. They included hand hygiene problems, contaminated surfaces, unclean equipment and “visibly contaminated” tweezers.

Khosravi said some of the infractions were due to construction upheaval but also attributed violations to improper conduct by staff.

“We had staff that was not following our rules and I’m not always in those locations so sometimes when I’m away they might do things . . . that they shouldn’t,” he said.

Inconsistent enforcement

Public health violations trigger widely inconsistent enforcement actions, regional statistics show. Health inspectors can issue formal orders requiring operators to comply if they have “reasonable or probable grounds” to believe that an immediate health hazard exists. Those who don’t comply can be taken to court and charged with a provincial offence.In Toronto, where there are roughly 3,000 personal service settings, public health officials issued 86 orders last year. Meanwhile health inspectors in York Region, which has almost 2,000 personal service settings, issued only three. In Ottawa, health inspectors have not written any formal orders in the past three years, although several shops have closed voluntarily after health infractions were found.

Peel Region, which has more than 1,000 personal service settings, issued 13 orders last year. The municipality was the subject of a class-action lawsuit in 2009 triggered by lax sterilization procedures, raising concerns that more than 3,000 customers at a tattoo parlour could have been exposed to hepatitis or HIV.

Peel compensated patrons of the tattoo parlour in an out-of-court settlement in 2011.

“The province is not fulfilling its constitutional responsibility if it doesn’t bring in a uniform standard of regulation and policing in a situation like this,” said Todd J. McCarthy, the lawyer who represented the class-action plaintiffs. “It shouldn’t sit idly by and allow a regulatory patchwork to exist.”

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